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Analyzing and adjusting for variables in a large-scale standardized-patient examination
J B Battles1, J L Carpenter, D D McIntire
1Office of Medical Education, University of Texas Southwestern Medical Center, Dallas Southwestern Medical School 75235-9065.
Summary
Standardized patient examinations using parallel forms are fair for large student groups. Minor adjustments like mean equating minimize potential score variations from factors like time or specific patient actors.
Area of Science:
- Medical Education
- Clinical Skills Assessment
- Standardized Patient Methodology
Background:
- Large-scale clinical performance exams often use parallel forms with different standardized patients (SPs) for the same case.
- These exams may be administered across different days and locations, introducing potential variability.
Purpose of the Study:
- To evaluate the impact of critical variables on standardized patient (SP) examinations.
- To assess the fairness and reliability of parallel-forms clinical performance assessments.
Main Methods:
- A univariate nested factorial analysis of variance was used for four annual SP examinations.
- The study analyzed approximately 200 second-year medical students per year.
- Variables examined included day, time of day, exam form, and sequencing effects.
Main Results:
- Time of day and day of examination showed small, inconsistent significant effects.
- Sequencing effects were significant for the first two stations across all years.
- Differences between standardized patients (SPs) portraying the same case were statistically significant each year.
Conclusions:
- The parallel-forms examination format demonstrates minimal impact from evaluated variables, ensuring fair pass/fail assessment.
- Mean equating is an effective method for reducing the influence of variables on pass/fail decisions in homogeneous student groups.